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This Week in JAMA
JAMA. 2007;298:715.
HPV Vaccine Among Infected Women
Human papillomavirus (HPV) vaccines appear to prevent infection through generation of neutralizing antibodies. Some data suggest HPV vaccination may also induce a cell-mediated immune response, which in theory could help clear the virus in women already infected. Hildesheim and colleagues (SEE ARTICLE), writing for the Costa Rican HPV Vaccine Trial Group, report results of a randomized trial that assessed rates of type-specific HPV viral clearance among women who received 3 doses of a bivalent HPV-16/18 candidate vaccine compared with control group women who received a hepatitis A vaccine. The investigators found no evidence of increased HPV virus clearance after 2 doses (6 months) or 3 doses (12 months) of the HPV vaccine. In an editorial, Markowitz (SEE ARTICLE) discusses the implications of this lack of therapeutic effect for current HPV vaccination guidelines.
Dietary Patterns and Survival After Colon Cancer
Certain dietary patterns are associated with an increased risk of colon cancer, but little is known about the effects of dietary pattern on colon cancer recurrence and survival. In an analysis of data from patients with stage III colon cancer enrolled in a randomized trial that compared 2 adjuvant chemotherapy regimens, Meyerhardt and colleagues assessed the association of a prudent diet (high fruit and vegetable, whole grains, poultry, and fish intakes) vs a "Western" diet (high meat, fat, refined grains, and dessert intakes) on cancer recurrence and survival. During a median follow-up of 5.3 years, the authors found that patients in the highest Western diet intake quintile had a significantly increased risk of cancer recurrence and mortality compared with patients in the lowest quintile. The prudent dietary pattern had no effect on recurrence or mortality.
(SEE ARTICLE)
Diabetes, Mortality, and Acute Coronary Syndromes
Cardiovascular disease is the leading cause of death among persons with diabetes. To assess the independent association of diabetes with 30-day and 1-year mortality following acute coronary syndromes (ACS), Donahoe and colleagues analyzed pooled data from the TIMI Study Group clinical trials. In analyses that controlled for baseline characteristics, features of the ACS event, and ACS management, the authors found that diabetes was independently associated with a significant excess mortality risk at both 30 days and 1 year following ACS.
(SEE ARTICLE)
Utility of Lipid Measures to Predict CHD
The role of apolipoproteins in the pathogenesis of coronary heart disease (CHD) has been elucidated in recent years, but consensus is lacking as to whether apolipoprotein (apo) A-I and apo B levels have greater utility than traditional lipids in predicting CHD risk. In an analysis of data from participants in the Framingham Offspring Study, Ingelsson and colleagues found that the apo B:apo A-I ratio was comparable with but not better than traditional lipid ratios (total cholesterol–high-density lipoprotein cholesterol [HDL-C] and low-density lipoprotein cholesterol–HDL-C ratios) in predicting incident CHD.
(SEE ARTICLE)
CLINICIAN'S CORNER
Targeting HDL-C
Clinical Review
In a systematic review of the literature, Singh and colleagues assessed the effects of high-density lipoprotein cholesterol (HDL-C) on clinical outcomes and the value of current and emerging strategies to modify HDL-C levels.
(SEE ARTICLE)
A Piece of My Mind
"I was . . . on both sides of the fence: physician and patient, understanding the vanishing likelihood of meaningful survival and struggling to define the meaning of ‘meaningful.’" From "The Other Side."
(SEE ARTICLE)
Medical News & Perspectives
Increasing numbers of drug shortages and discontinuations in recent years have left physicians and patients scrambling to find alternative sources or effective alternatives.
(SEE ARTICLE)
Academic Practice
Factors associated with a successful academic practice plan.
(SEE ARTICLE)
Mortality and Quality Measures
Implications for palliative and end-of-life care when mortality rates are made a measure of hospital quality.
(SEE ARTICLE)
Author in the Room Teleconference
Join Roy C. Ziegelstein, MD, August 15 from 2 to 3 PM eastern time to discuss acute emotional stress and cardiac arrhythmias. To register, go to http://www.ihi.org/AuthorintheRoom.
Audio Commentary
Dr DeAngelis summarizes and comments on this week's issue. Go to http://jama.ama-assn.org/misc/audiocommentary.dtl
JAMA Patient Page
For your patients: Information about acute coronary syndromes.
(SEE ARTICLE)
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